PELVIC PAIN & ENDOMETRIOSIS

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May is Pelvic Health Awareness Month , a time to shine a light on the vital role the pelvis and pelvic floor play in women’s overall well-being. Pelvic health involves taking care of the muscles and organs in the lower belly so they function properly and feel good. Yet many women don’t realize how important pelvic health is until problems arise. In fact, about one in three women will experience a pelvic health condition at some point in their lives, and these conditions can significantly impact daily comfort and quality of life. This month (and every month), we aim to raise awareness, educate, and encourage open conversation about pelvic health Common Pelvic Health Concerns Women’s pelvic health can be affected by several common conditions. Here is a brief overview: ● Pelvic Organ Prolapse : This occurs when the muscles and tissues that support pelvic organs (like the uterus, bladder, or rectum) weaken or loosen. As a result, an organ can “drop” or press into the vaginal canal. Women with prolapse may feel a bulge or heaviness in the pelvis, especially during activities or lifting, and sometimes experience bladder or bowel changes. Many women are embarrassed to discuss these symptoms, but prolapse is treatable with options like pelvic floor therapy, pessary devices, or surgery ● Urinary Incontinence: Incontinence is the involuntary leakage of urine, ranging from occasional drips (for example, when coughing or sneezing) to a sudden strong urge that can’t be controlled. It affects about one in three women worldwide, often related to pregnancy, childbirth, or menopause. Importantly, urinary incontinence is not a normal part of aging and is treatable Treatments include pelvic floor muscle exercises and other therapies. Early help can prevent it from seriously affecting daily life. ● Endometriosis: Endometriosis happens when tissue like the uterine lining grows outside the uterus, on ovaries, fallopian tubes, or other pelvic sites This condition affects roughly 10% of women of reproductive ageIt often causes severe pelvic pain (especially with periods or intercourse), heavy menstrual bleeding, and sometimes infertility Endometriosis can lead to chronic inflammation, scar tissue, and painful adhesions, so early diagnosis and management are crucial. ● Chronic Pelvic Pain: Chronic pelvic pain is ongoing, non-cyclic pain in the pelvis lasting six months or longer. It can have many causes (or even none clearly identified) and often coexists with other issues like endometriosis, irritable bowel syndrome, or interstitial cystitis Studies estimate that 6–27% of women worldwide suffer from chronic pelvic pain. Because it can be complex, successful management usually involves a multidisciplinary approach (medication, therapy, physical therapy, etc.) tailored to each woman. ● Uterine Fibroids: Fibroids are benign (non-cancerous) tumors that grow in the wall of the uterusThey are very common – up to 80% of women have fibroids by menopause – though many have no symptoms. When fibroids do cause problems, women may experience heavy menstrual bleeding, pelvic pain or pressure. Large fibroids can press on the bladder or bowel, leading to urinary frequency or constipationTreatments range from medication to minimally invasive procedures, depending on symptoms and goals. Each of the above issues is common in women’s health and highlights why paying attention to pelvic symptoms is so important. Future posts in this series will explore these topics in depth, but first it’s key to recognize them and know that effective care is available. Early Detection and Open Conversation Early diagnosis and regular gynecologic care are vital for pelvic health. Women’s health providers are trained to evaluate pelvic concerns. During a routine exam, your provider can check for issues or recommend tests (like pelvic ultrasound) and treatments (such as pelvic floor physical therapy) if needed If you notice any changes – for example, new pelvic pain, unusual pressure, or bladder/bowel leaks – do not hesitate to mention them. Many women feel embarrassed to bring up pelvic symptoms or think they are “just normal,” but that silence can delay help Remember that urinary incontinence and pelvic pressure are not “normal” parts of aging, and there is nothing shameful about seeking help. Talking openly with your doctor can lead to earlier, less invasive treatments. In fact, learning about the pelvic floor can help you spot problems early. Being informed makes you an active partner in your care. Regular checkups also allow your provider to address other aspects of pelvic health (for example, discussing pelvic floor exercises, lifestyle changes, or preventive screenings). In short, don’t wait to speak up – early action can make pelvic conditions much easier to manage. Ready to Take the Next Step? Dr. Hema Jonnalagadda and the team at Advocare Montgomery Gynecology are committed to providing compassionate, expert care for all aspects of women’s pelvic health. If you’re experiencing symptoms or simply want to stay proactive, we’re here to help. 👉 Visit our practice page to learn more or book an appointment today. Your pelvic health matters—and you don’t have to navigate it alone.

Understanding a Normal Menstrual Cycle A healthy menstrual cycle typically lasts between 21 and 35 days, with bleeding occurring for 3 to 7 days. The amount of blood loss is usually between 30–80 mL per cycle. A normal period should: ● Be fairly predictable each month. ● Not be excessively heavy or painful. ● Not interfere with daily activities. When bleeding patterns change—becoming too frequent, too heavy, or happening outside of your usual cycle—it may be time to seek medical advice. When Bleeding Becomes a Concern Abnormal uterine bleeding (AUB) refers to any bleeding that is outside of the normal menstrual pattern. It can be due to structural issues, hormonal imbalances, or other medical conditions. The PALM-COEIN classification system helps doctors determine the cause: Common Causes of Abnormal Bleeding Structural Causes (PALM) Polyps: Small tissue growths in the uterus or cervix that can cause irregular bleeding. Adenomyosis: When the uterine lining grows into the muscle, leading to heavy and painful periods. Fibroids: Non-cancerous growths in the uterus that can increase bleeding. Endometrial Hyperplasia or Cancer: Abnormal thickening of the uterine lining, which may cause postmenopausal bleeding Non-Structural Causes (COEIN) Hormonal Imbalances (Ovulatory Dysfunction): Conditions like PCOS, thyroid disorders, or perimenopause can lead to irregular cycles. Blood Clotting Disorders: Conditions such as von Willebrand disease may cause excessive menstrual bleeding. Medications: Certain birth control methods, anticoagulants, and hormone therapy can impact bleeding patterns. Other Causes: Sometimes, the exact cause remains unknown but can still be managed effectively. Types of Abnormal Bleeding Heavy Periods (Menorrhagia) Bleeding that lasts longer than 7 days or soaks through multiple pads/tampons per hour. Common causes: Fibroids, adenomyosis, blood clotting disorders. Irregular or Unpredictable Bleeding Bleeding between periods (Metrorrhagia) or very light, inconsistent cycles (Oligomenorrhea). Common causes: Hormonal imbalances, polyps, perimenopause. Bleeding After Menopause Any bleeding after 12 months of no periods is considered abnormal. Requires immediate evaluation for possible underlying conditions, including cancer. Diagnosis: What to Expect at Your Doctor’s Visit To determine the cause of abnormal bleeding, your doctor may recommend: Blood tests to check hormone levels and rule out clotting disorders. Ultrasound to evaluate the uterus and ovaries. Endometrial biopsy to check for abnormal tissue growth. Hysteroscopy to directly examine the inside of the uterus. Treatment Options Treatment depends on the cause of the bleeding, your overall health, and whether you are planning future pregnancies. Options include: Medication-Based Treatments Hormonal Therapy: Birth control pills, IUDs, or progesterone therapy to regulate cycles. Tranexamic Acid & NSAIDs: Reduce heavy bleeding without hormones. Iron Supplements: Help prevent anemia due to heavy bleeding. Minimally Invasive Procedures Endometrial Ablation: A procedure to reduce or stop bleeding by thinning the uterine lining. Hysteroscopy: To remove polyps or fibroids inside the uterus. Uterine Artery Embolization: A non-surgical option to shrink fibroids. Surgical Options (If Needed) Myomectomy: Removes fibroids while preserving the uterus. Hysterectomy: A last-resort option for severe cases where other treatments fail. When to See a Specialist If you are experiencing any of the following, it’s time to schedule an appointment: Bleeding that lasts longer than a week or is unusually heavy. Bleeding between periods or after menopause. Severe cramping or pain that disrupts your daily activities. Signs of anemia, such as fatigue, dizziness, or shortness of breath. Take Control of Your Health Abnormal bleeding doesn’t have to control your life. Dr. Hema Jonnalagadda, M.D., at Advocare Montgomery Gynecology, is dedicated to providing expert, personalized care to help you find relief. If you have concerns about your menstrual health, don’t wait—schedule a consultation today to get answers and the best treatment options available.

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